Project Summary The project seeks to adapt and test the feasibility of two brief online writing interventions capable of reducing the stress pathways underlying lesbian, gay, and bisexual (LGB) emerging adults? (ages 18-29) disproportionate experience of substance use, HIV risk behavior, suicidality, and depression. Given their low- cost and high portability, these interventions can circumvent barriers to health in geographies without LGB- affirmative resources. We will develop and pilot test these two interventions in the high stigma, low resource context of Appalachian Tennessee, one of the most stigmatizing and impoverished climates surrounding LGB emerging adults in the U.S. The Expressive Writing (EW) intervention asks LGB emerging adults to write about stressful stigma-related events, enabling cognitive-affective processing of stigma-related stress, with pilot support for reducing depression and health-risk behaviors. The Self-Affirmation (SA) intervention asks LGB emerging adults to write a letter to a hypothetical distressed LGB peer in which they advise the peer how best to cope with stigma. This type of ?saying is believing? intervention has previously improved emotional and behavioral self-regulation among other vulnerable emerging adults. The current proposal will adapt these interventions to be culturally relevant and engaging for Appalachian LGB emerging adults and pilot test their efficacy against a control. In Aim 1, we will conduct elicitation research with 10 Appalachian LGB emerging adults and 10 Appalachian LGB community leaders in order to understand (a) the type and frequency of sexual minority stressors they face to create the EW prompts and SA vignettes, and (b) current strategies Appalachian LGB emerging adults utilize to cope with these stressors to guide assessment selection. In Aim 2, we will present Aim 1 results to 10 additional community members and leaders to refine the EW prompts and SA vignettes and the LGB-affirmative, culturally relevant look-and-feel of the online platform. We will identify, with these leaders, promising venues and materials for participant recruitment and retention, and identify effective modalities for future intervention dissemination. In Aim 3, we will pilot test feasibility and efficacy of the interventions by randomizing 108 Appalachian LGB emerging adults to Expressive Writing, Self- Affirmation, or Control conditions. They will be asked to complete outcome measures (depressive symptoms, suicidality, substance use, HIV risk) and proposed mechanisms (circulating cortisol, behavioral and emotional self-regulation) at baseline, post-intervention, and 3-month follow-up. Follow-up interviews with 15 participants will help refine study procedures as we scale up this intervention to be tested in a future RCT. Study findings will also be used to estimate the effect sizes of the mediators of intervention efficacy for use in this future test. These culturally relevant, evidence-based interventions are poised to be the first to reduce mental and physical health disparities among LGB emerging adults in rural areas, who are severely impacted by minority stress, thereby addressing a most pressing public health goal of the U.S. Department of Health and Human Services.